The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors

Abstract

Introduction We investigated the prognostic effect of lymph nodes metastasis in aortopulmonary (AP) zone in resected non-small cell lung cancer of the left upper lobe (LUL).

Methods Between 1998 and 2010, 181 patients with LUL carcinoma underwent complete resection and were retrospectively analyzed. The patients were divided into four groups according to N status: N0 (n = 68, 37.6%), N1 (n = 64, 35.3%), N2^5,6+ (only metastasized to stations 5 and/or 6, n = 36, 19.9%), and N2⁷⁺ (only metastasized to stations 7, n = 13, 7.2%). N1 were divided according to single and multiple (N1^single n = 49, N1^multiple n = 15) or peripheral and hilar (N1^peripheral n = 39, N1^hilar n = 25).

Results Overall 5-year survival rate was 55.1%. Five-year survivals were 76.1% for N0, 54.3% for N1, and 20.7% for N2. N1^peripheral had a better survival than N1^hilar (60.3 vs. 29.4%, p = 0.09). Five-year survival of N1^single was 60.1%, whereas it was 36.6% for N1^multiple (p = 0.02). Five-year survival rate was 24.6% for N2^5,6+. Skip metastasis for lymph nodes in AP zone (n = 13) was a factor of better prognosis as compared to nonskip metastasis (n = 23) (29.9 vs. 19.2%). There was no statistically significant difference between the N2^5,6+ and N1^hilar (p = 0.772), although N1^peripheral had a significantly better survival than N2^5,6+ (p = 0.02). AP zone metastases alone had a significantly worse survival than N1^single (p = 0.008), whereas there was no statistically significant difference between the N1^multiple and N2^5,6+ (p = 0.248). N2⁷⁺ was not expected to survive 3 years after operation. They had a significantly worse prognosis than N2^5,6+ (p = 0.02).

Conclusion LUL tumors with metastasis in the AP zone lymph nodes, especially skip metastasis, were associated with a more favorable prognosis than other mediastinal lymph nodes. However, the therapy of choice for lung cancer with N2^5,6+ has not been clarified yet.

Keywords

non-small cell lung cancer - nodal involvement - N2 - aortopulmonary zone lymph node metastasis - surgical resection

Note

Presented at the Staging and Lymph Node Involvement Forum Session of the 27th European Association for Cardio-Thoracic Surgery Annual Meeting, Vienna, Austria, 5–9 October, 2013, and this article was nominated for the young researcher.

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